An experience of the menopause

One patient’s journey with ‘brittle’ diabetes through the menopauseJane Essex

I describe myself as a ‘dead woman walking’ in reference to having escaped catastrophe with my diabetes no fewer than three times. The first of these was the time I was brought, comatose, to the local hospital on Christmas Eve 1970, after the pathology labs had shut. Happily for me, a doctor who came on to the children’s ward to sing carols smelled ketones at a level that prompted him to administer insulin. I made it to Christmas morning, and so began my life with diabetes.

Adolescence brought with it a catastrophic decline in my control, but I was fortunate to be offered a very early insulin pump. It was an immediate success and transformed my life with diabetes. And so the next twenty-five years passed uneventfully, in terms of my diabetes. I resumed my studies, qualified as a teacher, married, worked and had three healthy children. I used the pump whenever I needed to get optimal blood sugar control, and had no more complications than the peripheral neuropathy that had been present three years after diagnosis. A charmed diabetic life? I thought so, until disaster loomed in 2007.

Firstly, I had a series of very unpleasant hypos, for which I had needed assistance, then came a series of episodes of sustained hyperglycaemia which were extremely resistant to additional insulin. Finally, there ceased to be any discernible correlation between the insulin I took or the food I had eaten. I stepped up my efforts at monitoring, switched to a very low carbohydrate diet and still, frustratingly for me, my family and diabetes care team there were no patterns, and hence no possible solutions emerged.

I discussed the problems with my hospital consultant, then my GP and practice nurse. Common causes of deteriorating control, such as coeliac disease and thyroid disease, were tested for and ruled out. Remembering the chaos of my adolescence, I ventured the notion that the approaching menopause could be to blame. So Hormone Replacement Therapy was instigated. Still, the random dips and surges of blood sugar continued. My carbohydrate-counting was double checked, but no errors were found with that either.

My life was being hi-jacked by my diabetes and I hated it. I was a frequent visitor to my local A&E department. Work and home life became increasingly difficult as I oscillated between uncomfortably high sugar levels, punctuated with unanticipated hypos. I had no energy for anything but the bare essentials. The health care professionals with whom I routinely dealt offered generous psychological support, but I was devastated that their kindly acceptance was the best I could aspire to. My HbA1c crept up from the mid 7s to a terrifying 10.4%. I felt as if my future was trickling away like sand between my fingers.

One fateful day I mentioned to my GP that I still couldn’t shake off the notion that this was related to the menopause. She instantly referred me to an international expert in pre-menstrual syndromes and explained that he could give me injections that would temporarily suppress my ovaries. If that helped my control, we would finally have crucial evidence about the cause of the instability. The first injection, which would act for a month, gave me a distinct improvement during the second and third weeks. I was thrilled! I returned in a state of high optimism for the next injection, this one to be active over three months. This time I was back to square one. No improvement at all, even though the consultant had not noted any differences previously with the three month injection. Was my hope of an answer to be dashed again? I spent much time in tears; every time I considered my future I could see nothing better ahead.

When I saw the gynaecologist again, he was of the opinion that the earlier improvement was probably unrelated to the injection. It was disappointing, he noted, but he had said at the outset that he only rated his chance of success as 50: 50. At this point I requested one final trial of the one-month formulation, simply to rule it out conclusively as the cause of the temporary improvement. Miraculously, as it seemed, my blood sugars showed the same improvement, again during weeks 2 and 3 which coincided with Christmas. Suddenly, I felt as if there was something to celebrate. I returned for another injection with real optimism, and by continuing to have the injections regularly was able to have adequate control for two out of every four weeks.

The next step was to find a dose of oestrogen that would deal with the problems created by the total loss of oestrogen but conserve the improved blood sugar control. Yet again I wasn’t a text book case, and quite small changes in dose caused some terrifying destabilisation of my control. However, trial and error established a dose that kept my glucose levels stable but protected against osteoporosis. Things were definitely improving; now I wanted weeks 1 and 4 back as well. So I requested the removal of my ovaries and, despite inevitable reluctance to perform surgery on people with diabetes, this was agreed by the gynaecological surgeon.

The wait for surgery seemed interminable, but after it was carried out the improvement was almost instantaneous; just three days after the surgery my blood sugars were already more stable. The following months saw my blood sugars becoming increasingly level, with variations that could be explained rather than occurring without warning. I am relishing having my life fully restored to me for the third time!